Background Minoritised young people face a double burden of discrimination through increased risk of stress and differential treatment access. However, acute care pathways for minoritised young people with urgent mental health needs are poorly understood.Aims To explore variation in stress-related presentations (SRPs) to acute hospitals across racial-ethnic groups in England.Method We examined rates

Background Social prescribing is growing rapidly globally as a way to tackle social determinants of health. However, whom it is reaching and how effectively it is being implemented remains unclear.Aims To gain a comprehensive picture of social prescribing in the UK, from referral routes, reasons, to contacts with link workers and prescribed interventions.Method This study undertook the first analyses

Immigration policies designed to deter people from seeking asylum are gaining traction in many Western nations, with the UK recently attempting to establish an offshore immigration processing centre in Rwanda. This letter outlines emerging evidence from Australia on the negative long-term psychological effects of offshore processing on people seeking asylum.

Background An important contributor to the decreased life expectancy of individuals with schizophrenia is sudden cardiac death. Arrhythmic disorders may play an important role herein, but the nature of the relationship between schizophrenia and arrhythmia is unclear.Aims To assess shared genetic liability and potential causal effects between schizophrenia and arrhythmic disorders and electrocardiogram

Background Personalised management of recurrent depression, considering individual patient characteristics, is crucial.Aims This study evaluates the potentially different mediating role of mindfulness skills in managing recurrent depression using mindfulness-based cognitive therapy (MBCT) among people with varying depression severity.Method Data from the Prevention of Depressive Relapse or Recurrence

Antipsychotic medications targeting dopamine receptors were identified 70 years ago. Recent clinical trials have shown that agonists of muscarinic acetylcholinergic receptors can improve both psychotic and negative symptoms in schizophrenia. Here, this new approach to the treatment of schizophrenia is reviewed in anticipation of the drugs being licensed clinically.

Background Attempts to use artificial intelligence (AI) in psychiatric disorders show moderate success, highlighting the potential of incorporating information from clinical assessments to improve the models. This study focuses on using large language models (LLMs) to detect suicide risk from medical text in psychiatric care.Aims To extract information about suicidality status from the admission notes

Background Breast cancer is a major global health issue, especially among women. Previous research has indicated a possible association between psychiatric conditions, particularly schizophrenia, and an increased risk of breast cancer. However, the specific risk of breast cancer in women with schizophrenia, compared with those with other psychiatric disorders and the general population, remains controversial

Background Positive, negative and disorganised psychotic symptom dimensions are associated with clinical and developmental variables, but differing definitions complicate interpretation. Additionally, some variables have had little investigation.Aims To investigate associations of psychotic symptom dimensions with clinical and developmental variables, and familial aggregation of symptom dimensions

Evidence indicates that ketamine is highly effective, has a lower side effect profile and is better tolerated compared to many augmentation strategies for refractory depression. This, combined with data on psychiatric treatment outcome mediators, suggests that earlier intervention with ketamine could improve outcomes for patients suffering from refractory depression.

An important change in ICD-11 is the lifespan approach, whereby previous child and adolescent disorders have been amalgamated with adult disorders. There have been changes in the definition/descriptions of neurodevelopmental and disruptive disorders, some of which may have an impact on service development.

Background Medications are commonly used to treat co-occurring psychopathology in persons with borderline personality disorder (BPD)Aims To systematically review and integrate the evidence of medications for treatment of co-occurring psychopathology in people with BPD, and explore the role of comorbidities.Method Building on the current Cochrane review of medications in BPD, an update literature search

This guest editorial describes the importance of converging genetics and psychosocial epidemiology research methods to understand the biopsychosocial etiology of psychiatric phenotypes.

Insight in psychosis is associated with reduced psychotic symptom severity, less coercive treatment and better functioning. Controversially, it has been suggested that insight may lead to depression, higher suicide risk and worse self-perceived quality of life. Future clinical trials are warranted to address this ‘insight paradox’, particularly the direction of causality.

This editorial considers the value and nature of academic psychiatry by asking what defines the specialty and psychiatrists as academics. We frame academic psychiatry as a way of thinking that benefits clinical services and discuss how to inspire the next generation of academics.

Background ‘Inhalants’ have been associated with poorer mental health in adolescence, but little is known of associations with specific types of inhalants.Aims We aimed to investigate associations of using volatile substances, nitrous oxide and alkyl nitrates with mental health problems in adolescence.Method We conducted a cross-sectional analysis using data from 13- to 14-year-old adolescents across

Twenty years ago, the British Journal of Psychiatry published an editorial regarding racism and psychiatry. Three decades ago, the journal published a lecture by Professor Michael Sheperd about Kraepelin's contributions to racist degeneration theories. A century ago, Albert Einstein visited the Brazilian Academy of Sciences, where he was hosted by Juliano Moreira [1872–1933], one of the most distinguished

Background Observational studies have shown a controversial relationship between dietary fat intake and Alzheimer's disease, and the causal effects are unclear.Aims To assess the causal effects of total fat, saturated fat and polyunsaturated fat (PUF) intakes on the risk of Alzheimer's disease.Method A two-sample Mendelian randomisation analysis was performed using genome-wide association study summary

Background Systemic changes in multiple diseases may influence the onset of dementia. However, the specific temporality between exposure diseases and dementia remains uncertain.Aims By characterising the full spectrum of temporal disease trajectories before dementia, this study aims to yield a global picture of precursor diseases to dementia and to provide detailed instructions for risk management

Background Understanding how childhood psychosocial adjustment (CPA) influences later life health outcomes is crucial for developing interventions to mitigate the long-term risk of cardiometabolic diseases (CMDs).Aims To investigate the association between CPA and incident CMDs in mid-life, and the mediating roles of educational attainment, smoking habits and depression during young adulthood.Method

Background Understanding inequalities in outcomes between demographic groups is a necessary step in addressing them in clinical care. Inequalities in treatment uptake between demographic groups may explain disparities in outcomes in people with first-episode psychosis (FEP).Aims To investigate disparities between broad demographic groups in symptomatic improvement in patients with FEP and their relationship

The release of ICD-11 has resulted in an expansion of diagnostic entities for trauma- and stress-related disorders. This resulted, at least temporarily, in discrepancies with the DSM-5. This situation is outlined and a look is taken at the potential diagnosis of ‘continuous traumatic stress reaction’.

Background Previous studies have indicated associations between maternal mental disorders and adverse birth outcomes; however, these studies mainly focus on certain types of mental disorders, rather than the whole spectrum.Aims We aimed to conduct a broad study examining all maternal mental disorder types and adverse neonatal outcomes which is needed to provide a more complete understanding of the

Coinciding with the 75th anniversary of John Cade's seminal publication that first reported lithium's antimanic efficacy, we briefly recount the salient findings of the historic paper and draw attention to the important psychiatric research in Britain that reinforced its findings and the critical British opinions that likely impeded its clinical use.

Oloyede and colleagues advocate for updating haematological monitoring requirements for clozapine, arguing that current protocols overestimate the risk of clozapine-induced agranulocytosis. Their research suggests that stringent monitoring may unnecessarily limit access to clozapine, a crucial treatment for resistant schizophrenia. The editorial supports calls for international consensus to carefully

While clozapine has risks, relative risk of fatality is overestimated. The UK pharmacovigilance programme is efficient, but comparisons with other drugs can mislead because of reporting variations. Clozapine actually lowers mortality, partly by reducing schizophrenia-related suicides, but preventable deaths still occur. Clozapine should be used earlier and more widely, but there should be better monitoring

The National Health Service Race and Health Observatory provides an evidence-based approach to tackling racial disparities in health and making policy recommendations. Its Mental Health Advisory Group is responsible for commissioning research into racial and ethnic disparities in mental health, and in this regard, improving access to psychological therapies became a key focus.

In our ever digitalising society, our engagement with the online world has significant potential to have a negative impact on our mental health. Although the roles of public health and psychiatry are debated, clinicians are in a strategic position to assess usage and intervene, to prevent harms from problematic engagement with the internet.

This editorial summarises the clinical relevance of ‘chronopsychiatry’, defined as the interface between circadian science and mental health science. Chronopsychiatry represents a move towards time-variable perspectives on neurobiology and symptoms, with a greater emphasis on chronotherapeutic interventions.

Broadening prediction efforts from imminent psychotic symptoms to neurodevelopmental vulnerabilities can enhance the accuracy of diagnosing severe mental disorders. Early interventions, especially during adolescence, are vital as these disorders often follow a long prodromal phase of neurodevelopmental disturbances. Child and adolescent mental health services should lead a developmentally-sensitive

Acknowledging the impact of imperialist and colonialist attitudes on the development of psychiatry allows for the recovery of the work of practitioners whose contribution may have been overlooked, as well as recognising racist attitudes in predominant thinking. These combined approaches aid in the construction of a more complete critical history.

The malicious use of artificial intelligence is growing rapidly, creating major security threats for individuals and the healthcare sector. Individuals with mental illness may be especially vulnerable. Healthcare provider data are a prime target for cybercriminals. There is a need to improve cybersecurity to detect and prevent cyberattacks against individuals and the healthcare sector, including the

The biopsychosocial model remains a key paradigm for healthcare, despite widely recognised scientific and philosophical shortcomings. Here we report on recent updates integrating evolutionary theory with the biopsychosocial model to provide a more comprehensive and scientifically complete approach to understanding the multiple relevant levels of causation of medical and psychiatric problems.

Summary Prominent clinical perspectives posit that the interface of autism and (borderline) personality disorder manifests as either a misdiagnosis of the former as the latter or a comorbidity of both. In this editorial, we integrate these disparate viewpoints by arguing that personality difficulties are inherent to the autistic spectrum.

We emphasise the existence of two distinct neurophysiological subtypes in schizophrenia, characterised by different sites of initial grey matter loss. We review evidence for potential neuromolecular mechanisms underlying these subtypes, proposing a biologically based disease classification approach to unify macro- and micro-scale neural abnormalities of schizophrenia.

Background Clozapine is the most effective medication for treatment-resistant psychoses, but the balance of benefits and risks is understudied in real-world settings.Aims To examine the relative re-hospitalisation rates for mental health relapse and adverse events associated with clozapine and other antipsychotics in adult and child/youth cohorts.Method Data were obtained from the Canadian Institute

Background Despite strong evidence of efficacy of electroconvulsive therapy (ECT) in the treatment of depression, no sensitive and specific predictors of ECT response have been identified. Previous meta-analyses have suggested some pre-treatment associations with response at a population level.Aims Using 10 years (2009–2018) of routinely collected Scottish data of people with moderate to severe depression

This editorial describes the Cass Review findings and the extraordinary challenge we all face in managing uncertainty amid a toxic and highly polarised debate. Children and young people will only get the best care if patients and professionals join forces to seek answers collaboratively and respectfully.

We address the unconsciously biased perception of psychiatric disorders, highlighting a hierarchical perspective that favours certain diagnoses over others. We aim to uncover reasons for these inequities, emphasising the need for a shift toward pathophysiology-based nomenclature that can promote equal support for each disorder, enhance treatment adherence and encourage open discussions.

With assisted dying becoming increasingly available to people suffering from somatic diseases, the question arises whether those suffering from mental illnesses should also have access. At the heart of this difficult and complex matter are values such as equality and parity of esteem. These issues require humane deliberation.

Background Clozapine is the most effective antipsychotic for treatment-resistant psychosis. However, clozapine is underutilised in part because of potential agranulocytosis. Accumulating evidence indicates that below-threshold haematological readings in isolation are not diagnostic of life-threatening clozapine-induced agranulocytosis (CIA).Aims To examine the prevalence and timing of CIA using different

Background Evidence linking air pollutants and the risk of schizophrenia remains limited and inconsistent, and no studies have investigated the joint effect of air pollutant exposure and genetic factors on schizophrenia risk.Aims To investigate how exposure to air pollution affects schizophrenia risk and the potential effect modification of genetic susceptibility.Method Our study was conducted using

Background Childhood trauma is a major risk factor for chronic depression. It has been suggested that adults with chronic depression who have experienced childhood trauma may require long-term treatment owing to a breakdown of basic trust and related difficulties in developing a productive therapeutic relationship.Aims As empirical studies have been preliminary and scarce, we studied the effects of